Organ Donation

Organ transplants have the potential to bless persons with the gift of extended life. As stewards of the gifts of grace and life, Christians can interpret and utilize transplant technology to serve God’s purposes. Organ donation can give redemptive, life-giving meaning to a tragic death.

Advances in medical technology have made transplant operations and organ donation commonplace. The well-publicized cases of celebrities who have made or received donations have raised public awareness. Some states print permission to donate statements on the back of each driver’s license. Media appeals by physicians and prospective donors well publicize the continued shortage of available organs. Because many of the thousands of deaths that occur each day create potential donor situations requiring split-second, difficult decisions, it is crucial for Christians to be well-informed and to think clearly on this issue.

The use of tissue and organs of one person for the benefit of another is not new. The first efforts at human blood transfusion occurred in the early nineteenth century. Pioneering work in understanding blood types and the immune system brought the first real success in human organ transplants in the mid-twentieth century. Today the transplantation of corneas, kidneys, lungs, livers, hearts, pancreases and spleens is considered standard medical procedure. Rates of transplantation surgery are increasing as rapidly as the availability of organs allows.

Transplantation is an effective life-saving medical technology. Technological success notwithstanding, Christians need good information to make good decisions.

Legal Issues

One large area of concern is the legal determination of consent. Most of the discussion focuses on cadaveric donation, i.e., donation upon the death of the donor. Generally, the legalities of organ donation are defined by the Uniform Anatomical Gift Act (UAGA). The UAGA emphasizes the potential donor’s autonomy in the decision to donate organs. If donor cards (including driver’s licenses) are properly completed, then the UAGA authorizes transplant surgery upon the donor’s death. No further permission is required.

In practice; however, the wishes of the potential donor, even when set forth in appropriate legal statements, are subject to approval by other parties. For example, almost all hospitals do not act on the basis of a donor card alone, but with the corroborating consent of the legal surrogate. This policy may be motivated by respect for the family or out of fear of litigation.

In some states so-called “required request” laws require hospital personnel or physicians to ask the legal surrogate to consider organ donation. Federal regulations require hospitals receiving federal funds to inform families about the option of organ donation. In all states, if the donor’s wishes have not been legally stated, then the decision is left to the legal surrogate. Partly because Americans do not understand the concept, there has been little support in the United States for the “presumed consent” laws that are common in Europe. Under presumed consent, organs are removed routinely for transplant unless the individual has recorded objections to such actions.

The Shortage of Organs

Current estimates from the United Network for Organ Sharing (UNOS) are that as many as 60,000 persons are awaiting transplants and that 4,000 people die each year because of the scarcity of organs. Despite repeated media reporting on this dilemma, the supply of organs remains far below the need. Recent polling indicates that approximately two-thirds of adults would be willing to donate organs of family members. Less than half of those surveyed; however, would be willing to donate their own organs. Fewer than twenty percent had completed an organ donation consent form. Throughout the United States less than fifteen percent of available organs are donated.

Several explanations help to account for the short supply of organs. In the case of living donor gifts, a proper match of donor and recipient must be made in order that the probability of success is sufficiently high. For some, consenting to this procedure is neither a quick nor easy decision, even if the donor is a close relative of the recipient.

Cadaveric donations are initiated while a family is grieving. The family is asked to wrestle with this decision in the midst of great stress and loss. Having knowledge of the patient’s desires can ease this burden. Grief, emotional pain, guilt and fatigue work against clarity of thought. There may also be feelings of resentment toward the medical establishment because its interventions were unable to save the deceased person. Questions may even be asked as to whether all possible efforts were made to save the person’s life, especially when organs are being requested. Grieving family members may also wonder if consenting to organ donation might delay or alter funeral arrangements, such as viewing the body.

In some instances social customs or religious beliefs may inhibit willingness to make cadaveric donations. Some may believe that death with dignity requires an intact body. Historically, our society has exhibited a strong emphasis on respect for the dead.

Another reason for the shortage of donors may result from the suspicious attitude some people hold toward technological advance as threatening to human life. For these persons, advances in transplant surgery fall into this suspect category.

Biblical and Theological Considerations

Resistance to organ donation is sometimes founded on religious beliefs, which may or may not be articulated by the potential donor. Christian teaching offers biblical and theological insights that speak to these beliefs and that give Christians guidance in making decisions about organ donation.

The Integrity of the Body and Resurrection Some Christians hold beliefs about resurrection, which assume an intact physical body is necessary for future life. Resurrection is largely viewed as a resuscitation of the physical body. This belief maintains that for one to have a real future existence, the present physical body must be “available.”

This line of thinking is highly problematic and raises many questions. If resurrection depends upon a whole physical body upon which the power of God can work, what about physically impaired Christians? What about those whose bodies and/or remains have been almost totally destroyed in fire, natural catastrophes or war? What about Christian martyrs whose bodies were devastated in their martyrdom? What about all of the Christians throughout history who have chosen to be cremated?

The Bible helps us to resolve these questions. Several passages indicate that the decomposition of the physical body is an inevitable, natural process and that the Christian hope of resurrection is not tied to the continued existence of the physical body (I Corinthians 15:50-56; II Corinthians 5:1-10). The most pertinent passage for understanding the nature of the resurrection body is I Corinthians 15:35-44:

But someone will ask, “How are the dead raised? With what kind of body do they come?” Fool! What you sow does not come to life unless it dies. And as for what you sow, you do not sow the body that is to be, but a bare seed, perhaps of wheat or some other grain. But God gives it a body as he has chosen, and to each kind of seed its own body. Not all flesh is alike, but there is one flesh for human beings, another for animals, another for birds, and another for fish. There are both heavenly bodies and earthly bodies, but the glory of the heavenly is one thing, and that of the earthly is another. There is one glory of the sun, and another of the moon, and another glory of the stars; indeed, star differs from star in glory. So it is with the resurrection of the dead. What is sown is perishable, what is raised is imperishable. It is sown in dishonor, it is raised in glory. It is sown in weakness, it is raised in power. It is sown a physical body, it is raised a spiritual body.

The contrast between “physical body” and “spiritual body” is important to Paul’s understanding of resurrection. In resurrection, says Paul, the physical body will be superseded by the spiritual body, much as a bare seed gives way to the plant that springs from it.

The physical body displays both continuity and discontinuity with the spiritual body. The physical body is suited for the needs of earthly physical existence. The spiritual body is suited for future spiritual existence. Paul sees the resurrection body as substantial but not as a body restored to its former limited physical nature and function. The spiritual body of the resurrected believer is modeled after the glorified body of the resurrected Lord (Philippians 3:21).

The point of these verses is that the body the believer possesses after death is not the same as the earthly body. It follows that the perpetual integrity of our physical bodies is not prerequisite for the resurrection of Christians as spiritual bodies. Resurrection is dependent only on the grace and power of God, not upon human strategies. We prepare for resurrection through faith in Christ, not by preserving our physical bodies. For Christians to donate organs in no way compromises the promise of resurrection.

Reverence for Life The Bible consistently teaches a profound reverence for life. God meticulously and lovingly creates creation and calls creation good. God values all living things, especially persons in need. God listens to their cries and moves in their behalf. The most disenfranchised and forgotten persons in society do not escape God’s piercing and loving gaze. The embodiment and definitive expression of this loving care is, of course, Jesus the Christ.

As followers of Jesus, we are called to display this basic reverence for life in the way we live our lives. To the best of our ability, we are to serve and conserve other lives. Organ donation is clearly and powerfully an act of reverence for life. On the other hand, respect for the lives and bodies of potential organ donors and their families also expresses reverence for life.

Stewardship Organ transplants have the potential to bless persons with the gift of extended life. As stewards of the gifts of grace and life, Christians can interpret and utilize transplant technology to serve God’s purposes. Organ donation can give redemptive, life-giving meaning to a tragic death.

Ethical Issues

The medical community and larger society face a number of ethical issues relating to organ donation and transplantation:

Should patients who have received an organ and have subsequently lost the organ because of rejection or organ failure be considered for retransplantation, given the significantly lower success rate for retransplants?

Should organs be harvested from animals for transplantation into humans?

How can we insure the most equitable distribution of available organs to patients who are medically qualified to receive them?

How can we improve the process of gaining consent so as to increase the available number of organs without diminishing either the self-determination of prospective donors or the dignity of their families?

A great deal of discussion has taken place around this last question. In countries which practice presumed consent the supply for organs has kept up with demand. So far, presumed consent has been rejected in the United States possibly because a foolproof method to document an individual’s decision to opt out of the system has not yet been agreed upon and because presumed consent appears in the eyes many to infringe upon individual choice and dignity. Texas currently uses a form of mandated choice regarding organ donations in which citizens are asked about their willingness to donate in the process of renewing driver’s licenses. While this system maximizes individual choice and provides family members with clear evidence of that choice, only twenty percent of Texans have answered yes to the driver’s license donor question. Since some surveys indicate a significantly higher percentage of citizens who had the opportunity to think deeply about the issue are willing to donate, the practice of asking the donor question point blank to persons standing in a driver’s license renewal line needs to be modified.

Family Matters

Christian responsibility concerning organ donation entails making the best decision possible for everyone involved in the donation/transplantation process. Valuing persons and being sensitive to all legitimate interests are central to decision making.

Families of donors and recipients need the best information to make the best decision in this pressing context. Medical personnel can meet this need by providing straightforward and clear communication.

The donor family is almost always involved in a very stressful situation even before the donation decision arises. Whatever they decide about donation, family members should receive affirmation, wisdom and support from the Christian community.

Families of donors should not be subjected to prolonged delays for the removal of organs. Such delays only make matters more difficult for all involved.

If the potential donor has expressed a clear intent and has completed the proper forms, the family should execute the patient’s expressed wishes. Families of potential recipients should avoid pressuring or manipulating potential donors, donor families or medical personnel.

Conclusion

Christians should always seek to minister to persons dealing with complex, agonizing decisions in medical ethics. This ministry should include intercessory and petitionary prayer, counseling, affirmation and tangible assistance with material needs.

Christians should work for just and equitable healthcare systems so more of those in need can receive adequate care. This effort is nowhere more needed than in the arena of organ donation where the demand for life-saving transplantation far exceeds the availability of organs.

“Organ Donation” is one of fourteen articles in the Getting Well: Christian Perspectives on Health, Sickness, and Ministry series. Getting Well deals with major health and biomedical issues.